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Alinity hq

Acute Myeloid Leukemia (AML)

Description

This patient presented with leukocytosis, normochromic normocytic anemia and thrombocytopenia. The lymphocyte count was suspect, and the monocyte and basophil counts were invalidated. In addition, immature granulocytes (IGs) were present, and the Left Shift, VAR LYM and BLAST flags were triggered.

 

Scatterplots showed the presence of overlapping populations of lymphocytes, monocytes and neutrophils. This pattern suggests the presence of abnormal cells that triggered the VAR LYM and BLAST flags. In addition, the presence of immature myeloid cells resulted in the Left Shift flag. The RBC volume histogram showed the presence of dual population of cells, potentially due to blood transfusion. This would also explain the greatly increased RDW values.

 

The peripheral smear showed a heterogenous appearance with different forms of immature granulocytic cells, including dysplastic hypogranular eosinophils. 26% of the cells were immature granulocytes (promyelocytes, metamyelocytes and myelocytes) and there were about 24% blast cells. The blasts were large with central nuclei, fine uncondensed chromatin and prominent nucleoli. The cytoplasm showed the presence of fine cytoplasmic granules.

 

These results are consistent with a diagnosis of acute myeloid leukemia (AML). AML patients usually present with leukocytosis, normochromic, normocytic anemia and thrombocytopenia. The diagnosis of AML requires the presence of at least 20% blasts in the peripheral blood and further classification is made by morphology, cytogenetics, flow cytometry and cytochemistry (Hutchison).

Numerical ResultsInvalid Data

 
WBC 24.6 10e3/μL
NEU 7.53 10e3/μL 30.6 % Left Shift
LYM 5.99 10e3/μL 24.3 % VAR LYM
MONO 6.06X 10e3/μL 24.6X % BLAST
EOS 1.66 10e3/μL 6.73 %
BASO .272X 10e3/μL 1.10X %
IG 3.11 10e3/μL 12.6 %
NRBC .227 10e3/μL
NR/W .922

 
RBC 2.88 10e6/μL
HGB 9.04 g/dL
HCT 25.9 %
MCV 90.0 fL
MCH 31.4 pg
MCHC 34.9 g/dL
RDW 20.1 %

 
RETIC 31.5 10e3/μL 1.09 %
IRF .384
MCHr 32.6 pg

 
PLT 21.4 10e3/μL
MPV 5.63 fL
%rP 31.0 %

 
FIGURE 1. IAS X ALL (WBC):
Intermediate angle light scatter vs. size plot
There is significant overlap among the lymphocyte (cyan), monocyte (purple) and neutrophil (yellow) populations. This pattern suggests the presence of abnormal cells and contributed to the BLAST and VAR LYM flag.
FIGURE 2. FL1 X ALL (WBC):
Fluorescence vs. size
This scatterplot shows the presence of overlapping populations of lymphcytes (cyan), monocytes (purple) and neutrophils (yellow). In addition, a small population of NRBC (red) is visible on the lower portion of the scatterplot.
FIGURE 3. ALL X PSS (WBC):
Size vs Polarized Side Scatter plot
The neutrophil cluster (yellow) is spread out indicative of neutophils in various stages of differentiation (immature blast forms to mature neutophils). In addition, the neutrophil population is shifted downward along the y-axis, indicating reduced degree of nuclear segmentation and granularity, due to the large number of immature cells.
FIGURE 4:
Representative image from patient’s smear
Image of patient’s smear shows presence of neutrophils in various stages of maturation from immature blast forms (1) to other immature granulocytes (IGs); promyelocytes (2), myelocytes (3), and metamyelocytes (4).
Alinity hq Casebook. Acute Myeloid Leukemia (AML). ADD-00061876-v3 2020. p.48-49

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